Eustachian canals or middle ears, by a suction current of air pulling it from these locations back into the throat, whereas, inflation is an attempt to remove it by blowing it further into the tubes and middle ears. The first is a safe sanitary procedure, the latter decidedly the

reverse.

In dilating the Eustachian canals it is a painless, safe and sanitary procedure, when the ears are first rarefied and then dilated with a gradual, steady and continuous pressure of air from a compressed air-tank; and my observation is that what such a torce will not do will scarcely be effected by passing catheters and bougies, which are perhaps septic, into a mucous membrane so delicate that almost the tenderest touch will bring blood.

Passing on, we invade the field of massage and compete with the various compressed-air, electric and water motor vibrations.

These all are of the same degree of efficiency; they effect a movement of the tympanic membrane and one bone only, because of the slip-lock between the malleus and incus. The bone moved is the malleus, and autopsies have proven the cause of deafness to be usually an involvement of one or both of the other two bones when the tympanum is intact; and to cure the great majority of cases we should massage, move and bring new blood to those not reached by the massage instruments in general use. It is a reasonable contention that the rarefier does this by removing the air from the oval and round windows, thereby allowing the arterioles so richly ramifying in the lymph of the labyrinth to dilate and force these windows with the chain bones outward into the middle ear. The air on the outside of the tympanic membrane having been removed at same time as that from the middle ear, there is no resistance

to such pressure coming from the labyrinth, except such as adhesions of the crura and bones might offer. When these can be overcome we get vibration and hearing even in the deaf and dumb, when the air-pressure is again normal. The entire ear feels the massage effect of the rarefier, and provision is made for retracting the tympanic membranes and for placing them outward, or one in and the other out, by the use of the shut-offs on the tubular branches of the rarefier.

In carrying medication to the ears from the nebulizer it is well to use the rarefier and prevent pressure on the membranes from one side only; and in using dry heated air you get it applied hot and held to all the parts so long as the patient keeps the cheeks distended. I think there is much to be claimed for this method of applying dry heated air. It is applied inside and outside, and can be held there long enough to be effective. The usual treatment is to apply the heated air into the external auditory canal.

This way is not of much effect, because as soon as the air is allowed to expand the heat is lost, and the force of the current is objectionable to the patient. Another practice is to pass a catheter into the Eustachian canals and force the heated air through it into the middle ear. Objection to this method is the passing of the catheter, which might set up a septic condition.

The pressure applied to one side of the tympanum and the small amount of heat, the middle ear full of air will retain. Under pressure with the rarefier the heated air circulates and there is a constant renewal of the heat, and the pressure is steady and continuous.

I want now to speak a word about the douche for the ears. I use the douche for cleansing the middle ears. I force the water through the Eustachian canals in the usual way, and immediately follow it with the rarefier to

pump it out. rarefying has

bad effects.

When there has been pain following, the given prompt relief, and I have had no

By pumping out the ears every other day with the rarefier it appears a reasonable hope that deafness would be prevented in cases of diphtheria and the eruptive fevers, because the infected mucus, which is said to be the cause, would be removed.

Finally, I wish to show you a clinic and such practitical results as will convince all, except those moved by prejudice, that neither citatious from so-called eminent authorities, arraying of old deaf and dumb statistics by one knowing how they can not be cured, but not how to cure them, nor personal flings from one holding a payless job at a deaf and dumb school or any uninformed one or two man-power opposition as exhibited at our last meeting can ignore or combat successfully.

I wish you to judge whether there is a state of deafmutism that does not depend upon any condition other than a hypertrophic and hyperplastic involvement of the mucous membrane of the Eustachian canals and middle ears; and it is for you to say whether or no these once deaf and dumb have been made to hear and talk.

14 mt

INCURABLE HEADACHES-REPORT OF A

CASE.

BY V. D. LOCKHART, M. D., MAYSVILLE.

Were it not for the hope that this brief paper may appeal to your interest in a way to evoke discussion, especially upon the subject of treatment, it would not have been presented.

Headaches like the case here described, I have called incurable, not because they are in reality incurable, but because they do not yield to treatment with the means at our command in common practice.

We all know that headache, as a rule, is a reflex manifestation of diseased conditions outside of the cranium. Faulty digestion, diseased kidneys, ocular disturbances and various other lesions more or less remote are to be sought out and corrected by appropriate treatment.

The case which I desire to report I have had examined by competent specialists in Atlanta and in New York, with negative results as to errors of accommoda. tion and refraction. He is a business man, married, --years old, of splender build, quick-motioned, bright intellect. Uses tobacco very moderately; has no intemperate habits; is free from specific taint; heart and lungs normal; no history of consumption in the family. His father had very severe attacks of headache up to the time of his death, at seventy-four years of age. Attacks were said to have been much lighter after he had passed fifty years of age.

Mother still living-neurotic type. came on during the latter end of the

Attacks usually

week, most fre

quently on Saturday afternoon. He comes into the office and implores me to do something for his head, and declares that he can not live through the night in his present condition. His face is slightly paler than usual, and the eyes turned away from the light. The pain is described as a keen burning and throbbing in and behind the eyeballs, sometimes to one side of the head and through the temple. He often declares that it feels as if the pain could be cut out with a knife. Very often the whole frontal and parietal region suffers, rarely the back of the head. Without nausea or vomiting the pain grows more intense. The patient at times morose and fretful, rolling on the bed or walking to and fro in the room. Often be lies down and covers his head with a blanket or shawl made hot by the fire. By 8 or 9 o'clock P. M. he either drops into a deep, muttering slumber and wakes every twenty to twentyfive minutes, or he becomes wild and almost crazy. I have seen him walk to and fro, throwing his arms and talking in quite loud and fretful delirium, sometimes threatening to destroy himself, for an hour at a time almost. About midnight, under the effect of chloral and the bromides, he drops into a stupor, circulation weak, pulse 110 to 115, skin dry. A free action of the kidneys takes place, and by morning the attack passes off, leaving the patient weak and much exhausted.

During the past eight years, during all of which time I have been his family physician, I have tried almost all of the remedies recommended for headaches with but very little effect. Opiates render him wild, almost crazy, increasing both pain and the delirium. few years ago one of his attacks came on while he was away from home. A doctor was called in, and, although

A